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12/28/2010 TUE B: 51 FAX �002/002
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<br /> ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org /2��"g�-�O
<br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ����Za 6�
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<br /> PROJECT ADDRESS
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<br /> Owner MailAddress Cily StaleiZip Phone
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<br /> Tenant Mail Address `-- �- Cily Slate2lp Phone
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<br /> ElectricalConiraclor MailAddress Cily StateRip Phone
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<br /> State License Number Contract Price of Work
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<br /> Proposed Use o(Building Contact Person (Plan Review)
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<br /> DescriptionofWorktoBeDone: I � 1:�- .c.fi: I ir �, 'jl�..:.1 � li`1���-` �;1, � ((:,.�.�t�.� (.: Il,' � � l� i. � �' l'.-.l�"j;
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<br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE
<br /> BE IN R.4CEWAYS, MC OR AC CAEiLE.
<br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105
<br /> I Imreby ceRi7y Ihat 1 have read and examined fhis applicafion and know fhe same fo be trua and � I^� I 2_ r ��
<br /> wnecL All provisions ol laws and ordinances govonunq Ihis lype ol work will be complefed �V
<br /> whefher speci/ed horoin or noL The granfing ol a permif does nof presumo to give aufhonty lo
<br /> violafoorcancel!ho provisronso(unyofhersfateo�locallawregulalingconstrucfionor(hc
<br /> pedormsrice oI conslruUion. That I om aufhodzed by tho owner ol lhis property(o peAom�fhe
<br /> work lordvhich applicafion is made and 1 compty wi(h Iho Stefe Conlracturs Law 78.27 RCW and
<br /> 296.200 WAC. .
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<br /> � -. , Signaturq��. � . Date
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